Monitoring food and health news -- with particular attention to fads, fallacies and the "obesity" war

Summary of findings to date: Everything you can possibly eat or drink is both bad and good for you

"Let me have men about me that are fat... Yond Cassius has a lean and hungry look ... such men are dangerous." -- Shakespeare

Thursday, December 09, 2010

Treating people like lab rats

When it comes to UK health policy, dodgy Nudge-style psychology is just as oppressive and poorly-founded as New Labour nannying

Last week, the health secretary for England, Andrew Lansley, published a White Paper that reflects the triumph of hope over experience. That’s because its theoretical foundation is ‘nudging’, the in-vogue American social policy tool that has long infatuated prime minister David Cameron and has now captured Lansley’s policy heart, too.

In Nudge, authors Richard Thaler and Cass Sunstein candidly describe how nudging works. As most of us act irrationally (and predictably so) much of the time, it takes an elite group of rational thinkers to design choices that encourage the rest of us to choose the ‘right’ option. Hence Cameron and Lansley are determined to shepherd us towards ‘good’ decisions through nudges.

What they ignore, however, is that the behavioural economics research that nudging relies upon is closer to science fiction than first-class science. The vast majority of its conclusions come from laboratory experiments that are completely artificial in their construction, as Nobel laureate economist Gary Becker, among many others, has cautioned.

Still, the White Paper assures us that government intervention will be based ‘on a rigorous assessment of the evidence’. Yet the same document then proposes plain packaging for cigarettes - for which there is absolutely no compelling evidence - and procrastinates over whether to implement a tobacco retail display ban, despite a plethora of sound studies finding that there are no public-health benefits.

The White Paper is also full of contradictions. So while warning that lifestyle-driven health problems such as obesity are at alarming levels, it confirms that ‘people in England are healthier and are living longer than ever’, and that ‘life expectancy is expected to continue to rise for both men and women’. Furthermore, ‘although we are living longer, there is no strong evidence that the burden of health conditions has increased’. In addition, the reader is correctly informed that childhood obesity rates are leveling off, and that the majority of the population either doesn’t drink or drinks in sensible moderation.

A flimsy theoretical foundation, compounded by a series of contradictory statements, is further tarnished by a litany of nonsensical assertions that reveal either the Department of Health’s stunning ignorance of the research evidence or a political decision to present a particular side of the argument to further a preordained policy agenda. The faulty policies and misinformation contained in the White Paper include the following:

An expansion of the ludicrous Change4Life programme

This policy assumes that government-directed, population-wide behavioural change with respect to diet, weight and physical activity levels is possible. Interventions based on creating such behavioural change almost always rely on theories, such as cognitive learning and the theory of planned behaviour, that have rarely been subjected to rigorous evaluation; where they have, they have generally been found to be spectacular failures. There is considerable evidence that community-level interventions designed to modify physical activity and food consumption patterns have been unsuccessful.

Eating ‘five a day’ will keep the doctor away

According to the White Paper, only three out of every 10 adults eat the recommended ‘five a day’ servings of fruits and vegetables. The White Paper assumes that ‘eating better’ can reduce the risk of disease and death. But there is little evidence from randomised clinical trials that supports any of the claims that reductions in fat and calories and increases in fibre, fruits and vegetables can reduce the risk of certain diseases, delay death, or prevent weight gain. Indeed, some of the largest of these trials, such as the Women’s Health Initiative Dietary Modification Trial, found no statistically significant differences in the risk of breast cancer, colon cancer, coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) between the intervention and control groups.

If we ‘move more’ we will lose weight and live longer

There is no compelling evidence that such exhortations have any efficacy in terms of weight loss or longevity in either adults or children. For example, Yale University professor of epidimeology, Dr Loretta DiPietro, notes that, based on the long-term evidence, ‘It is not clear that increased physical activity prevents or reverses age-related weight gain at the population level’. The evidence is even less compelling with children. Numerous studies have failed to find a link in children between physical activity levels, food intake, and obesity. In fact, there is considerable evidence that neither better sports and physical education facilities, nor improved programmes or increased hours of physical education in schools, will reduce childhood overweight and obesity.

Most serious illness is lifestyle-related

Two out of three British adults are either overweight or obese and the government assumes that the overweight and obese are at risk of premature death. The government also assumes that most serious illness is lifestyle-driven: ‘a substantial proportion of cancers and… deaths from circulatory disease could be avoided.’

Neither of these assumptions is true. A rigorous academic study by Dr Katherine Flegal and her colleagues found the weight group with the lowest death rate was overweight, while Dr Jerome Gronniger’s analysis found negligible differences in risk of death among people with body mass index (BMI) values from 20 to 35 (that is, from ‘normal’ right through to ‘mildly obese’). Flegal et al’s seminal study reported no relationship between overweight and excess mortality for cardiovascular disease (CVD) or coronary heart disease. For cancer there was no relationship between excess mortality and overweight and obesity. In the Million Women Study, for all the cancers studied overweight was not associated with a statistically significant mortality risk, while with obesity the association was a barely significant 1.1 (in other words, a 10 per cent increase in risk).

In fact, being overweight actually increased one’s chance of living longer. And for all other diseases other than CVD and cancer, obesity up to a BMI of 35 was modestly protective – that is, being plump seems likely to result in a longer life. The US data was confirmed last year by a rigorous Statistics Canada study of the Canadian population.

Huge savings would accrue to the NHS from less obesity and fewer smokers

The stubborn fact is that preventing obesity and smoking doesn’t save taxpayers’ money. It costs more to care for healthy people who live years longer, according to an economic study led by the Dutch National Institute for Public Health and the Environment. The researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.

Tougher anti-drinking measures are necessary

This is despite the fact the UK recently recorded the biggest fall in alcohol consumption in 60 years, according to the British Beer and Pub Association (BBPA). The BBPA’s new Statistical Handbook reveals that there was a six per cent decline in alcohol consumption in 2009 – the sharpest decrease since 1948. It was also the fourth annual decline in five years; British drinkers are now consuming 13 per cent less alcohol than in 2004. Alcohol consumption in the UK remains below the EU average.

There’s also one assumption that is missing, but well supported by the research evidence…

Those who don’t drink tend to die sooner than those who do

A new paper in the journal Alcoholism: Clinical and Experimental Research suggests that abstaining from alcohol tends to increase one’s risk of dying even when you exclude former drinkers. In fact, abstainers’ mortality rates are also higher than those of heavy drinkers. Moderate drinking is associated with the lowest mortality rates in alcohol studies.

The overall implications of the White Paper’s glaring deficiencies are significant. They suggest that a good deal of the government’s public-health message lacks a credible scientific basis. Consequently, Cameron and Lansley’s kinder, gentler Nudge State will not succeed where the coercive Nanny State has demonstrably failed.

A simple blood test can predict if someone is going to have a heart attack up to six years before it occurs, researchers have said. A team in America have adapted a test normally used to establish if someone if having a heart attack to predict one years in advance. The development could allow those at high risk to take action such as adopting a healthier lifestyle and taking drugs to lower blood pressure and cholesterol levels.

The more sensitive test identified proteins in the blood that signal heart cells have been dying in seemingly healthy people with no outward signs of heart disease.

It was found that where the protein called troponin T were present, the patient was seven times more likely to die from heart disease within the next six years.

Dr James de Lemos, associate professor of internal medicine at Southwestern Medical Centre, at University of Texas and lead author of the study said: "This test is among the most powerful predictors of death in the general population we've seen so far.

"It appears that the higher your troponin T, the more likely you are to have problems with your heart, and the worse you're going to do, regardless of your other risk factors."

The findings are published in the Journal of the American Medical Association and follow on from an earlier study which suggested the protein could also predict heart failure, a condition where the organ fails to pump strongly enough causing breathlessness and fatigue.

The latest study involved more than 3,500 healthy people and 25 per cent were found to have detectable levels of troponin T.

They provided blood samples and underwent multiple body scans to examine their hearts and internal organs.

They found older people, men and African-Americans had the highest levels of troponin T along with those showing signs of thickening or weakness of the heart muscles.

They were then tracked for an average of seven years from 2000 to 2007 to establish how many people died, of what and when.

The more sensitive test can detect circulating protein levels in almost everyone with chronic heart failure and chronic coronary artery disease, the authors said.

Dr de Lemos said: "Because this test seems to identify cardiovascular problems that were previously unrecognised, we hope in the future to be able to use it to prevent some death and disability from heart failure and other cardiac diseases."

Currently doctors use computer software calculations called the Framingham Score and Qrisk to identify people at high risk of heart disease who could benefit from preventive treatments. The calculations take into account family history, smoking history, cholesterol levels, blood pressure and age.

The earlier study, published in the same journal last month, found that troponin T levels could predict the chance of heart failure up to 15 years in advance. Until now, no blood test has been able to give an indication of a person's risk of heart failure.

The study conducted by University of Maryland involved 4,000 people whose blood was taken in 1989.

Prof Christopher deFilippi, the lead researcher, said: "We found that the higher the level of troponin T, the greater the individual was at risk for symptoms of heart failure or death from cardiovascular disease over the next 10 to 15 years."

He added that those with the highest levels of troponin T were four to five times more likely to develop heart failure than those with the lowest detectable levels. People whose levels dropped over time appeared to reduce their risk of heart failure.

Where it is not bunk is when it shows that some treatment or influence has no effect on lifespan or disease incidence. It is as convincing as disproof as it is unconvincing as proof. Think about it. As Einstein said: No amount of experimentation can ever prove me right; a single experiment can prove me wrong.

Epidemiological studies are useful for hypothesis-generating or for hypothesis-testing of theories already examined in experimental work but they do not enable causative inferences by themselves

The standard of reasoning that one commonly finds in epidemiological journal articles is akin to the following false syllogism:
Chairs have legs
You have legs
So therefore you are a chair

I am rather in despair that important medical research is plagued by arrant nonsense. The simple truth that correlation is not causation seems unknown to most medical writers. As a last ditch attempt to get that truth into a few more skulls let me be "offensive". Offensiveness may serve to get the matter noticed. So here is the story: There is about a -.5 correlation between lip size and IQ. Big lips predict low IQ. Your run-of-the mill medical researcher will pounce on that as a huge breakthrough in finding the causes of IQ -- and propound new theories about things such as blood circulation to explain how lips affect IQ. But that is nonsense. Big lips are mostly found on people of African ancestry and, as all the studies attest, Africans are a very low IQ group. The correlation arises because of heredity, not lip size. There is a third factor behind the correlation -- and the possibility of such third factors seems to be a jaw-dropping surprise to most medical researchers

SALT -- SALT -- SALT

1). A good example of an epidemiological disproof concerns the dreaded salt (NaCl). We are constantly told that we eat too much salt for good health and must cut back our consumption of it. Yet there is one nation that consumes huge amounts of salt. So do they all die young there? Quite the reverse: Japan has the world's highest concentration of centenarians. Taste Japan's favourite sauce -- soy sauce -- if you want to understand Japanese salt consumption. It's almost solid salt.

2). We need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. So the conventional wisdom is not only wrong. It is positively harmful

3). Table salt is a major source of iodine, which is why salt is normally "iodized" by official decree. Cutting back salt consumption runs the risk of iodine deficiency, with its huge adverse health impacts -- goiter, mental retardation etc. GIVE YOUR BABY PLENTY OF SALTY FOODS -- unless you want to turn it into a cretin

4). Our blood has roughly the same concentration of salt as sea-water so claims that the body cannot handle high levels of salt were always absurd

5). The latest academic study shows that LOW salt in your blood is most likely to lead to heart attacks. See JAMA. 2011;305(17):1777-1785. More here and here and here for similar findings. Salt is harmless but a deficiency of it is not. We need it. See also here

PEANUTS: There is a vaccination against peanut allergy -- peanuts themselves. Give peanut products (e.g. peanut butter -- or the original "Bamba" if you have Israeli contacts) to your baby as soon as it begins to take solid foods and that should immunize it for life. See here and here (scroll down). It's also likely that a mother who eats peanuts while she is lactating may confer some protection on her baby. See here

THE SIDE-EFFECT MANIA. If a drug is shown to have troublesome side-effects, there are always calls for it to be banned or not authorized for use in the first place. But that is insane. ALL drugs have side effects. Even aspirin causes stomach bleeding, for instance -- and paracetamol (acetaminophen) can wreck your liver. If a drug has no side effects, it will have no main effects either. If you want a side-effect-free drug, take a homeopathic remedy. They're just water.

Although I am an atheist, I have never wavered from my view that the New Testament is the best guide to living and I still enjoy reading it. Here is what the apostle Paul says about vegetarians: "For one believeth that he may eat all things: another, who is weak, eateth herbs. Let not him that eateth despise him that eateth not; and let not him which eateth not judge him that eateth." (Romans 14: 2.3). What perfect advice! That is real tolerance: Very different from the dogmatism of the food freaks. Interesting that vegetarianism is such an old compulsion, though.

Even if we concede that getting fat shortens your life, what right has anybody got to question someone's decision to accept that tradeoff for themselves? Such a decision could be just one version of the old idea that it is best to have a short life but a merry one. Even the Bible is supportive of that thinking. See Ecclesiastes 8:15 and Isaiah 22: 13. To deny the right to make such a personal decision is plainly Fascistic.

Obesity does NOT causes diabetes. But insatiable eating is a prominent symptom of diabetes. So diabetes DOES cause obesity, which accounts for the correlation between the two things. The streets are full of fatties who don't have diabetes. How come? If conventional medical theory were correct we should be in the midst of an epidemic of diabetes. A recent high quality study has also found that fatties are LESS likely to die of diabetes

Elite people frequently express disapproval of red meat eating as a way of expressing their felt superiority to the ordinary people who eat it

IQ: Political correctness makes IQ generally unmentionable so it is rarely controlled for in epidemiological studies. This is extremely regrettable as it tends to vitiate findings that do not control for it. When it is examined, it is routinely found to have pervasive effects. We read, for instance, that "The mother's IQ was more highly predictive of breastfeeding status than were her race, education, age, poverty status, smoking, the home environment, or the child's birth weight or birth order". So political correctness can render otherwise interesting findings moot

"To kill an error is as good a service as, and sometimes better than, the establishing of a new truth or fact" -- Charles Darwin

"Most men die of their remedies, not of their diseases", said Moliere. That may no longer be true in general but there is still a lot of false medical "wisdom" around that does harm to various degrees -- the statin and antioxidant fads, for instance. And showing its falsity is rarely the problem. The problem is getting people -- medical researchers in particular -- to abandon their preconceptions

Bertrand Russell could have been talking about today's conventional dietary "wisdom" when he said: "The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd; indeed in view of the silliness of the majority of mankind, a widespread belief is more likely to be foolish than sensible.”

The challenge, as John Maynard Keynes knew, "lies not so much in developing new ideas as in escaping from old ones".

"Obesity" is 77% genetic. So trying to make fatties slim is punishing them for the way they were born. That sort of thing is furiously condemned in relation to homosexuals so why is it OK for fatties?

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Some more problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize dietary fat. But Eskimos living on their traditional diet eat huge amounts of fat with no apparent ill-effects. At any given age they in fact have an exceptionally LOW incidence of cardiovascular disease. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

11). A major cause of increasing obesity is certainly the campaign against it -- as dieting usually makes people FATTER. If there were any sincerity to the obesity warriors, they would ban all diet advertising and otherwise shut up about it. Re-authorizing now-banned school playground activities and school outings would help too. But it is so much easier to blame obesity on the evil "multinationals" than it is to blame it on your own restrictions on the natural activities of kids

12. Fascism: "What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!

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Trans fats: For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.

The "antioxidant" religion: The experimental evidence is that antioxidants SHORTEN your life, if anything. Studies here and here and here and here and here and here and here and here, for instance. That they are of benefit is a great theory but it is one that has been coshed by reality plenty of times.

The medical consensus is often wrong. The best known wrongheaded medical orthodoxy is that stomach ulcers could not be caused by bacteria because the stomach is so acidic. Disproof of that view first appeared in 1875 (Yes. 1875) but the falsity of the view was not widely recognized until 1990. Only heroic efforts finally overturned the consensus and led to a cure for stomach ulcers. See
here and here and here.

Dieticians are just modern-day witch-doctors. There is no undergirding in double-blind studies for their usual recommendations

The fragility of current medical wisdom: Would you believe that even Old Testament wisdom can sometimes trump medical wisdom? Note this quote: "Spiess discussed Swedish research on cardiac patients that compared Jehovah's Witnesses who refused blood transfusions to patients with similar disease progression during open-heart surgery. The research found those who refused transfusions had noticeably better survival rates.

Medical wisdom can in fact fly in the face of the known facts. How often do we hear reverent praise for the Mediterranean diet? Yet both Australians and Japanese live longer than Greeks and Italians, despite having very different diets. The traditional Australian diet is in fact about as opposite to the Mediterranean diet as you can get. The reverence for the Mediterranean diet can only be understood therefore as some sort of Anglo-Saxon cultural cringe. It is quite brainless. Why are not the Australian and Japanese diets extolled if health is the matter at issue?

Since many of my posts here make severe criticisms of medical research, I should perhaps point out that I am also a severe critic of much research in my own field of psychology. See here and here

This is NOT an "alternative medicine" site. Perhaps the only (weak) excuse for the poorly substantiated claims that often appear in the medical literature is the even poorer level of substantiation offered in the "alternative" literature.

I used to teach social statistics in a major Australian university and I find medical statistics pretty obfuscatory. They seem uniformly designed to make mountains out of molehills. Many times in the academic literature I have excoriated my colleagues in psychology and sociology for going ga-ga over very weak correlations but what I find in the medical literature makes the findings in the social sciences look positively muscular. In fact, medical findings are almost never reported as correlations -- because to do so would exhibit how laughably trivial they generally are. If (say) 3 individuals in a thousand in a control group had some sort of an adverse outcome versus 4 out of a thousand in a group undergoing some treatment, the difference will be published in the medical literature with great excitement and intimations of its importance. In fact, of course, such small differences are almost certainly random noise and are in any rational calculus unimportant. And statistical significance is little help in determining the importance of a finding. Statistical significance simply tells you that the result was unlikely to be an effect of small sample size. But a statistically significant difference could have been due to any number of other randomly-present factors.

"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."

So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

The Truth About Ancel Keys. Keys was a brilliant man but his concentration on heart disease misled him. He was right that high fat intake predicted high rates of heart disease (though it was ANIMAL fat in particular that was the "culprit") but he overlooked that the same intake predicted LESS mortality from other causes. The same narrow vision led him to be the earliest prominent advocate of the "Mediterranean diet" hypothesis. It's true that Mediterraneans have less heart disease but they have more of other causes of death, so that Mediterranean countries do not have particularly long lifespans when compared with other developed countries. If there are any lessons about diet to be learned from lifespans, it is un-Mediterranean countries like Australia and the Nordic countries that one should look to.

The intellectual Roman Emperor Marcus Aurelius (AD 121-180) could have been speaking of the prevailing health "wisdom" of today when he said: "The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane."

Improbable events do happen at random -- as mathematician John Brignell notes rather tartly: "Consider, instead, my experiences in the village pub swindle. It is based on the weekly bonus ball in the National Lottery. It so happens that my birth date is 13, so that is the number I always choose. With a few occasional absences abroad I have paid my pound every week for a year and a half, but have never won. Some of my neighbours win frequently; one in three consecutive weeks. Furthermore, I always put in a pound for my wife for her birth date, which is 11. She has never won either. The probability of neither of these numbers coming up in that period is less than 5%, which for an epidemiologist is significant enough to publish a paper.

Kids are not shy anymore. They are "autistic". Autism is a real problem but the rise in its incidence seems likely to be the product of overdiagnosis -- the now common tendency to medicalize almost all problems.

One of the great pleasures in life is the first mouthful of cold beer on a hot day -- and the food Puritans can stick that wherever they like

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here